Universal femoral trial system and methods

ABSTRACT

Implant assemblies, systems, kits, and methods for replacing a knee joint may include a universal femoral trial component for preparing and trialing a femoral bone of a patient to receive a plurality of different femoral implant types. The assembly may include a body and drill guide and an attachment mechanism including first and second compressible tabs and a rotatable handle operationally connected to the first and second tabs. The universal femoral trial component may be configured to receive any of a plurality of femoral bone preparation attachments and any of a plurality of femoral trial attachments in order to facilitate the preparation and trialing of the femoral bone to receive the plurality of different femoral implant types.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part of U.S. patentapplication Ser. No. 15/622,688 filed on Jun. 14, 2017, entitled KNEEARTHROPLASTY SYSTEMS AND METHODS, which claims the benefit of U.S.Provisional Application No. 62/466,249 filed on Mar. 2, 2017, entitledCOMPOSITE JOINT ARTHROPLASTY SYSTEMS AND METHODS. The presentapplication is also a continuation-in-part of U.S. patent applicationSer. No. 16/046,554 filed on Jul. 26, 2018, entitled MODULAR KNEEPROTHESIS, which claims the benefit of U.S. Provisional Application No.62/537,106 filed on Jul. 26, 2017, entitled MODULAR KNEE PROSTHESIS. Thepresent application is also a continuation-in-part of U.S. patentapplication Ser. No. 16/505,595 filed on Jul. 8, 2019, entitledORTHOPEDIC IMPLANTS AND METHODS, which claims the benefit of U.S.Provisional Application No. 62/694,834 filed on Jul. 6, 2018, entitledORTHOPEDIC IMPLANTS AND METHODS. The present application is also acontinuation-in-part of U.S. patent application Ser. No. 16/046,583filed on Jul. 26, 2018, entitled UNIVERSAL FEMORAL TRIAL SYSTEM ANDMETHODS, which claims the benefit of U.S. Provisional Application No.62/537,106 filed on Jul. 26, 2017, entitled MODULAR KNEE PROSTHESIS. Theabove-referenced applications are incorporated by reference as thoughset forth herein in their entirety.

TECHNICAL FIELD

The present disclosure relates to surgical devices, systems,instruments, and methods. More specifically, the present disclosurerelates to orthopedic knee replacement surgical devices, instruments,systems, and methods.

BACKGROUND

A number of knee replacement options exist which may be implementeddepending upon the level of compromise of the natural knee anatomy. Theknee anatomy complex includes the knee joint between the femur distalend and the tibia proximal end, and the surrounding anterior andposterior cruciate ligaments (ACL, PCL), and medial and lateralcollateral ligaments (MCL, LCL), which provide support and stabilizationto the knee joint. When one or more ligaments are compromised, forexample through injury, disease, or aging, a knee prosthesis system maybe implanted to replace the knee joint.

In a situation where the anterior cruciate ligament is compromised, itmay be removed and a cruciate retaining (CR) knee prosthesis system,which allows retention of the posterior cruciate ligament and thecollateral ligaments, may be implanted. Typical CR knee prosthesisfemoral components and tibial inserts have large U-shaped openingsproviding room for the extant PCL, MCL, and LCL ligaments.

In a case where both the anterior and posterior cruciate ligaments arecompromised but, yet the collateral ligaments are functional, both theACL and PCL may be removed, and a posterior stabilizing (PS) kneeprosthesis system may be implanted. A typical PS tibial insert includesa central post, and many PS femoral components include a cam elementextending between the medial and lateral condyles. The post and caminteract to provide stability in place of the removed PCL ligament.

In a case where the anterior and posterior cruciate ligaments arecompromised, and the collateral ligaments are unstable, both the ACL andPCL may be removed and a constrained condylar knee (CCK) prosthesissystem may be implanted. In a case where all four ligaments arecompromised, all ligaments may be removed, and a hinge type kneereplacement system may be implanted.

A typical knee prosthesis system includes a tibial bone anchoringcomponent, a tibial articulating component, which may be called a tibialinsert, and a femoral bone anchoring component. Since the tibial andfemoral bone anchoring components are anchored to bone through variousfasteners, cement, and/o bone ingrowth, it may be difficult and invasiveto remove and replace either of the bone anchoring components, shouldthe need arise. The tibial insert is typically made of polyethylene, andsince it is not anchored to bone, is much more easily replaced ifnecessary. For example, a patient may have a CR knee prosthesis and thenexperience compromise of the PCL, thus requiring replacement of the CRknee prosthesis with a PS knee prosthesis. Or, a patient may have a PSknee prosthesis and then experience instability of the collateralligaments, thus requiring replacement of the PS knee prosthesis with aCCK prosthesis.

SUMMARY

The various systems and methods of the present disclosure have beendeveloped in response to the present state of the art, and inparticular, in response to the problems and needs in the art that havenot yet been fully solved by currently available technology.

In an embodiment, an assembly for facilitating orthopedic surgery mayinclude a body with a drill guide connected to the body and anattachment mechanism connected to the body. The attachment mechanism mayinclude a first tab, a second tab, and a handle connected to the firstand second tabs. The rotation of the handle about an axis may cause thefirst and second tabs to extend outward from the body to secure the bodyto an external frame secured to a patient. The drill guide may furtherinclude at least one drill guide aperture that extends through the drillguide and through the body. The drill guide may further include at leastone broach guide aperture that extends through the drill guide andthrough the body. The at least one drill guide aperture may be incommunication with the at least one broach guide aperture.

The first tab and the second tab each may have a proximal end and adistal end, and the proximal ends of the tabs may be adjacent to oneanother and the distal ends of the tabs may extend away from each other.The proximal ends of the tabs may each have a handle attachment featureand the handle may further include tab attachment features complementaryto the handle attachment features on each of the tabs. The rotation ofthe handle about the axis may cause each of the first tab and the secondtab to transition between a retracted position and an extended position,relative to the body. The proximal ends of the first and second tabs maybe located within a cavity in the body so that the handle attachmentfeatures and/or the tab attachment features extend into the cavity. Atleast one of the first tab and the second tab may further include a stopmember and the body may further include an abutment member. The rotationof the handle may cause the stop member to engage the abutment member toretain the at least one of the first tab and the second tab in theextended position.

The first and the second tabs each may have a proximal end, a distalend, and an intermediate section therebetween. The intermediate sectionmay be compressible such that the proximal end and the distal end areconfigured to be translatable. The assembly may further include theexternal frame which may be a trial component for joint arthroplasty.The first and second tabs each may have a proximal end, a distal end,and an intermediate section therebetween. The trial component may have areceiving aperture shaped to receive the body and locking apertures, incommunication with the receiving aperture, shaped to receive the distalends of the first tab and the second tab when the handle is rotated withthe body positioned in the receiving aperture.

In an embodiment, an assembly may include a body, and a drill and broachguide. The drill and broach guide may include a first drill guideaperture, a second drill guide aperture, a third drill guide aperture, afirst broach guide aperture intermediate the first drill guide apertureand the second drill guide aperture, and a second broach guide apertureintermediate the second drill guide aperture and the third drill guideaperture. The second drill guide aperture may be intermediate the firstbroach guide aperture and the second broach guide aperture. The assemblymay have a locking mechanism including a handle connected to the bodysuch that the handle is rotatable about an axis, a first tab having afirst proximal end, a first distal end, and a first compressibleintermediate section. The first proximal end may have a first handleconnection feature, a second tab having a second proximal end, a seconddistal end, and a second compressible intermediate section. The secondproximal end may have a second handle connection feature. The handle maybe movably connected to the first handle connection feature and thesecond handle connection feature such that rotation of the handle aboutthe axis extends the first and second tabs outward from the body.

The first and second tabs may be located within a cavity in the body. Atleast one of the first tab and the second tab may further have a stopmember. The body may further have an abutment member. Rotation of thehandle may cause the stop member to engage the abutment member to retainthe at least one of the first tab and the second tab in the extendedposition. The handle may further have a circular base and a gripportion. The circular base may have a concave surface. The body mayfurther have an aperture, surrounding the axis, extending from a firstsurface of the body to a second surface of the body. The circular basemay engage the aperture. The handle may be rotatably secured to the baseat the aperture by two pins extending into the base proximate an edge ofthe aperture, so that the pins securely engage the concave surface,allowing the handle to rotate about the axis.

The assembly may further include an external frame, which may be a trialcomponent for joint arthroplasty. The trial component may further have areceiving aperture shaped to receive the body and locking apertures, incommunication with the receiving aperture, shaped to receive the firstand second distal ends of the first tab and the second tab when thehandle is rotated with the body positioned in the receiving aperture.

In an embodiment, an assembly for preparing and trialing a bone toreceive an implant, may include a body, a drill guide connected to thebody, and an attachment mechanism connected to the body. The attachmentmechanism may further include a first tab, a second tab, and a handleconnected to the first and second tabs. The assembly may be configuredto be removably coupled to a trial component by rotating the handle suchthat the first tab and the second tab are first in the retractedposition, positioning the assembly adjacent to the trial component, androtating the handle such that the first tab and the second tab move tothe extended position and engage within corresponding attachmentapertures in the trial component. At least one of the first tab and thesecond tab may further include a stop member and the body may furtherhave an abutment member. The rotation of the handle may cause the stopmember to engage the abutment member to retain the at least one of thefirst tab and second tab in in the extended position or a retractedposition.

The first and the second tabs each may have a proximal end, a distalend, and an intermediate section therebetween. The handle may engage thefirst tab and the second tab at the proximal ends. The intermediatesection may be compressible, and the handle may be rotatable totransition the first and second tabs to the extended position so thatthe distal ends of the first and second tabs enter the correspondingattachment apertures in the trial component. The intermediate sectionmay be compressible such that, in response to the distal ends abutting asurface, the intermediate section is compressed to urge the stop memberagainst the abutment member and prevents rotation of the handle. Thedistal ends may be configured to abut a surface and cause a compressionof the intermediate section. The compression may urge the stop memberagainst the abutment member and prevent rotation of the handle. Theassembly may further include the external frame. The external frame maybe a trial component for joint arthroplasty and may further include areceiving aperture shaped to receive the body. The first and second tabsmay each have a proximal end, a distal end, and an intermediate sectiontherebetween. The frame may further have locking apertures, incommunication with the receiving aperture, shaped to receive the distalends of the first tab and the second tab when the handle is rotated withthe body positioned in the receiving aperture.

BRIEF DESCRIPTION OF THE DRAWINGS

The advantages, nature, and additional features of exemplary embodimentsof the disclosure will become more fully apparent from the followingdescription and appended claims, taken in conjunction with theaccompanying drawings. Understanding that these drawings depict onlyexemplary embodiments and are, therefore, not to be considered limitingof the disclosure's scope, the exemplary embodiments of the disclosurewill be described with additional specificity and detail through use ofthe accompanying drawings in which:

FIG. 1A is a perspective rear view of an assembly of the disclosure,including a posterior stabilizing femoral component and a tibial insertcoupled in extension; FIG. 1B is a perspective front view of theassembly of FIG. 1A in flexion;

FIG. 2 is an exploded view of the assembly of FIG. 1A;

FIG. 3A is a posterior view of the tibial insert of FIG. 1A; FIG. 3B isan anterior view of the tibial insert of FIG. 1A; FIG. 3C is a superiorview of the tibial insert of FIG. 1A; FIG. 3D is a medial side view ofthe tibial insert of FIG. 1A;

FIG. 4 is a top down view of the assembly of FIG. 1A;

FIG. 5 is a top down cross-sectional view of the assembly of FIG. 1A,taken along line B-B in FIG. 6;

FIG. 6 is a posterior cross-sectional view of the assembly of FIG. 1A,taken along line A-A in FIG. 5;

FIG. 7 is a top down cross-sectional view of the assembly of FIG. 1B,taken along line C-C in FIG. 8;

FIG. 8 is a posterior cross-sectional view of the assembly of FIG. 1B,taken along line D-D in FIG. 7;

FIG. 9 is a perspective rear view of an assembly of the disclosure,including a cruciate retaining femoral component and the tibial insertof FIG. 1A coupled in extension;

FIG. 10 is an exploded perspective rear view of the assembly of FIG. 9;

FIG. 11A is a perspective rear view of another tibial insert of thedisclosure; FIG. 11B is a top view of the tibial insert of FIG. 11A;FIG. 11C is a posterior view of the tibial insert of FIG. 11A; FIG. 11Dis an anterior view of the tibial insert of FIG. 11A; FIG. 11E is abottom view of the tibial insert of FIG. 11A;

FIG. 12A is a perspective rear view of another tibial insert of thedisclosure; FIG. 12B is a top view of the tibial insert of FIG. 12A;FIG. 12C is a bottom view of the tibial insert of FIG. 12A; FIG. 12D isa posterior view of the tibial insert of FIG. 12A; FIG. 12E is ananterior view of the tibial insert of FIG. 12A; FIG. 12F is a medialside view of the tibial insert of FIG. 12A;

FIG. 13 is a chart demonstrating the interchangeability of the tibialinserts disclosed herein with various femoral components;

FIG. 14 is an exploded rear view of another assembly of the disclosure,including a posterior stabilizing femoral component and a posteriorstabilizing tibial insert;

FIG. 15 is another exploded rear view of the assembly of FIG. 14;

FIG. 16A is a posterior view of the tibial insert of FIG. 14; FIG. 16Bis an anterior view of the tibial insert of FIG. 14; FIG. 16C is asuperior view of the tibial insert of FIG. 14; FIG. 16D is a medial sideview of the tibial insert of FIG. 14;

FIG. 17 is an exploded rear view of another assembly of the disclosure,including a cruciate retaining femoral component with a keel and theposterior stabilizing tibial insert of FIG. 14;

FIG. 18 is another exploded rear view of the assembly of FIG. 17;

FIG. 19 is an exploded rear view of another assembly of the disclosure,including a cruciate retaining femoral component without a keel and theposterior stabilizing tibial insert of FIG. 14;

FIG. 20 is another exploded rear view of the assembly of FIG. 19;

FIG. 21A is a perspective rear view of another tibial insert of thedisclosure; FIG. 21B is a top view of the tibial insert of FIG. 21A;FIG. 21C is a posterior view of the tibial insert of FIG. 21A; FIG. 21Dis an anterior view of the tibial insert of FIG. 21A; FIG. 21E is abottom view of the tibial insert of FIG. 21A;

FIG. 22A is a perspective rear view of another tibial insert of thedisclosure; FIG. 22B is a top view of the tibial insert of FIG. 22A;FIG. 22C is a bottom view of the tibial insert of FIG. 22A; FIG. 22D isa posterior view of the tibial insert of FIG. 22A; FIG. 22E is ananterior view of the tibial insert of FIG. 22A; FIG. 22F is a medialside view of the tibial insert of FIG. 22A;

FIG. 23A is a perspective front view of the femoral component of FIG. 14coupled to one or more augments of the present disclosure; FIG. 23B is amedial side view of the femoral component of FIG. 23A;

FIG. 24A is a perspective top view of a femoral trial component of thedisclosure; FIG. 24B is a perspective rear view of the femoral trialcomponent of FIG. 24A; FIG. 24C is a lateral side view of the femoraltrial component of FIG. 24A; FIG. 24D is a medial side view of thefemoral trial component of FIG. 24A; FIG. 24E is an anterior view of thefemoral trial component of FIG. 24A; FIG. 24F is a posterior view of thefemoral trial component of FIG. 24A; FIG. 24G is a superior view of thefemoral trial component of FIG. 24A; FIG. 24H is an inferior view of thefemoral trial component of FIG. 24A;

FIG. 25A is a perspective rear view of a posterior stabilizing notchcutting guide assembly of the disclosure; FIG. 25B is anotherperspective rear view of the posterior stabilizing notch cutting guideassembly of FIG. 25A; FIG. 25C is a medial side view of the posteriorstabilizing notch cutting guide assembly of FIG. 25A; FIG. 25D is a topview of the posterior stabilizing notch cutting guide assembly of FIG.25A;

FIG. 26 is a partial exploded view of the posterior stabilizing notchcutting guide assembly of FIG. 25A;

FIG. 27A is a posterior view of the posterior stabilizing notch cuttingguide assembly of FIG. 25A above the femoral trial component of FIG.24A; FIG. 27B is posterior view of the posterior stabilizing notchcutting guide assembly of FIG. 27A coupled to the femoral trialcomponent of FIG. 27A;

FIG. 28A is a perspective rear view of a posterior stabilizing trialattachment of the disclosure; FIG. 28B is another perspective rear viewof the posterior stabilizing trial attachment of FIG. 28A; FIG. 28C is aperspective front view of the posterior stabilizing trial attachment ofFIG. 28A; FIG. 28D is a perspective side view of the posteriorstabilizing trial attachment of FIG. 28A;

FIG. 29A is a posterior view of the posterior stabilizing trialattachment of FIG. 28A above the femoral trial component of FIG. 24A;FIG. 29B is a posterior view of the posterior stabilizing trialattachment of FIG. 29A coupled to the femoral trial component of FIG.29A;

FIG. 30A is a perspective rear view of a drill and broach guide assemblyof the disclosure; FIG. 30B is a perspective bottom view of the drilland broach guide assembly of FIG. 30A; FIG. 30C is a top view of thedrill and broach guide assembly of FIG. 30A; FIG. 30D is a bottom viewof the drill and broach guide assembly of FIG. 30A;

FIG. 31 is a partial exploded view of the drill and broach guideassembly of FIG. 30A;

FIG. 32A is a posterior view of the drill and broach guide assembly ofFIG. 30A above the femoral trial component of FIG. 24A; FIG. 32B is aposterior view of the drill and broach guide assembly of FIG. 32Acoupled to the femoral trial component of FIG. 32A;

FIG. 33A is a perspective front view of a cruciate retaining trialattachment of the disclosure; FIG. 33B is a perspective rear view of thecruciate retaining trial attachment of FIG. 33A; FIG. 33C is aperspective bottom view of the cruciate retaining trial attachment ofFIG. 33A; FIG. 33D is a top view of the cruciate retaining trialattachment of FIG. 33A;

FIG. 34A is a posterior view of the cruciate retaining trial attachmentof FIG. 33A above the femoral trial component of FIG. 24A; FIG. 34B is aposterior view of the cruciate retaining trial attachment of FIG. 34Acoupled to the femoral trial component of FIG. 34A;

FIG. 35A is a perspective rear view of another femoral trial componentof the disclosure; FIG. 35B is a posterior view of the femoral trialcomponent of FIG. 35A; FIG. 35C is an anterior view of the femoral trialcomponent of FIG. 35A;

FIG. 36 is a flow chart diagram of a method for preparing and trialing afemoral bone with a femoral trial component;

FIG. 37 is a flow chart diagram of a method for revising a knee jointprosthesis to provide increased stability;

FIG. 38A is a perspective front view of a tibial tray of the disclosure;FIG. 38B is a perspective rear view of the tibial tray of FIG. 38A; FIG.38C is an anterior view of the tibial tray of FIG. 38A; FIG. 38D is aposterior view of the tibial tray of FIG. 38A; FIG. 38E is a bottom viewof the tibial tray of FIG. 38A; FIG. 38F is a top view of the tibialtray of FIG. 38A; and

FIG. 39 is an exploded view of a tibial tray mounting system of thedisclosure that utilizes the tibial tray of FIG. 38A.

FIG. 40 is a perspective rear view of an embodiment of a drill andbroach guide assembly of the disclosure.

FIG. 41 is a side perspective view of the drill and broach guideassembly of FIG. 40.

FIG. 42 is a bottom view of the drill and broach guide assembly of FIG.40.

FIG. 43 is a partial exploded view of the drill and broach guideassembly of FIG. 40.

FIG. 44 is a partial exploded bottom perspective view of the drill andbroach guide assembly of FIG. 40.

It is to be understood that the drawings are for purposes ofillustrating the concepts of the disclosure and may not be to scale.Furthermore, the drawings illustrate exemplary embodiments and do notrepresent limitations to the scope of the disclosure.

DETAILED DESCRIPTION

Exemplary embodiments of the disclosure will be best understood byreference to the drawings, wherein like parts are designated by likenumerals throughout. It will be readily understood that the componentsof the disclosure, as generally described and illustrated in the Figuresherein, could be arranged and designed in a wide variety of differentconfigurations. Thus, the following more detailed description of theembodiments of the apparatus, instruments, systems, and methods, asrepresented in the Figures, is not intended to limit the scope of thedisclosure, as claimed, but is merely representative of exemplaryembodiments of the disclosure.

Disclosed herein are components for a modular knee prosthesis system.This system may allow for revision procedures by replacement of only thetibial insert, allowing the originally implanted femoral and tibialanchoring components to remain implanted. The system may include CRtibial inserts, PS tibial inserts, and/or CCK tibial inserts. Any one ofthese tibial inserts may be interchangeably used with CR and/or PSfemoral components disclosed herein to provide the stabilization neededto substitute for compromised or removed ligaments. The system may beused with any suitable tibial baseplate component, or tibial tray, tosupport the tibial insert. The PS tibial inserts disclosed herein mayinclude tapered posts that permit the inserts to be used with cruciateretaining (CR) femoral components and/or posterior stabilizing (PS)femoral components.

Referring to FIGS. 1A-2, an assembly 10 for an implantable kneeprosthesis is shown including a femoral component 14 and a tibial insert12. The femoral component 14 and tibial insert 12 are shown coupled inextension in FIG. 1A, coupled in flexion in FIG. 1B, and shown in anexploded view in FIG. 2. The tibial insert 12 may be further coupled toa tibial baseplate component (not shown) which may be implanted in aprepared tibia of a patient (also not shown). The femoral component 14and tibial insert 12 illustrated in FIGS. 1A-2 are right femoral andtibial insert components. Left femoral and tibial insert components (notshown) would be mirror images of the right femoral and tibial insertcomponents shown in FIGS. 1A-2. The femoral component 14 may also bereferred to as a posterior stabilizing femoral component 14 (or “PSfemoral component”) and the tibial insert 12 may also be referred to asa posterior stabilizing tibial insert (or “PS insert”).

FIGS. 3A-3D show the PS insert 12 of FIGS. 1A-2 in isolation. The PSinsert 12 may include a fixation side 20, which may be an inferior side,opposite an articulation side 22, which may be a superior side. Thearticulation side 22 may include a medial articulation portion 24 havinga medial condylar articulation surface 25 and a lateral articulationportion 26 having a lateral condylar articulation surface 27. A centralportion 28 may separate the medial articulation portion 24 from thelateral articulation portion 26. A post 30 may protrude superiorly fromthe central portion 28 and extend from a post base 38 to a post top orpost superior end 40. From the anterior perspective (shown in FIG. 3B)and/or the posterior perspective (shown in FIG. 3A), the post 30 mayhave its maximum medial-lateral or horizontal width toward the postsuperior end 40 of the post 30, and its minimum medial-lateral orhorizontal width toward the post base 38 of the post 30. The post 30 mayalso be bilaterally symmetrical from the anterior and/or posteriorperspectives. A recess 45 may be formed posterior to the central portion28, between the medial and lateral articulation portions 24, 26, and mayprovide room for a posterior cruciate ligament (not shown). The PSinsert 12 may further include an insert base 46, which may furtherinclude an engagement feature 48 for engagement with a tibial baseplatecomponent.

Continuing with FIGS. 1A-3D, the post 30 may have an articulationsurface 31 extending around the post 30 on the medial, posterior,lateral, and anterior aspects of the post 30. The articulation surface31 may include a medial articulation surface 32, a lateral articulationsurface 34, an anterior post surface 36, and a posterior articulationsurface 42. The medial and lateral articulation surfaces 32, 34 may benon-parallel to one another and taper inward from the post superior end40 to the post base 38 relative to an insert midline vertical axis 2, asshown in FIGS. 3A and 3B. As shown in FIG. 3A, an angle θ between thevertical axis 2 and each tapered surface 32, 34 may be about 6.5°, in atleast one embodiment. Since the post 30 may be bilaterally symmetrical,the angle θ may be the same on both the medial and lateral articulationsurfaces 32, 34 of the post 30. In other embodiments of the disclosure,angle θ may range from about 6° to 11° degrees. The medial articulationsurface 32 may be continuous with the medial condylar articulationsurface 25, and the lateral articulation surface 34 may be continuouswith the lateral condylar articulation surface 27, as can been furtherseen in cross-section in FIGS. 6 and 8. The anterior post surface 36 mayextend between the medial and lateral articulation surfaces 32, 34 andmay be convexly rounded. The anterior post surface 36 may also taperoutward from the post superior end 40 to the post base 38 relative tothe midline vertical axis 2, as best seen in FIG. 3D. In otherembodiments of the PS insert 12, the anterior post surface 36 mayinclude less or no taper.

Referring to FIG. 3C, the boundary of the post superior end 40 defines arounded rim 44 shaped as a portion of a circle defined by a circularenvelope 47, as seen from a superior perspective. The post superior end40 and rim 44 may be crescent-shaped with a concave recess toward aposterior end of the post 30 as shown, and may permit passage of theposterior cruciate ligament. The post superior end 40 may be circular;the rim 44 may provide increased rotational range of motion and surfacecontact against the femoral component 14 in comparison to traditionalposts with a more square or rectangular shape and no rim. Thus, therounded post superior end 40 and rim 44 may allow for surface contactwith the femoral component 14 in contrast to the mere point or edgecontact that is achieved by traditional posts that do not have thesefeatures.

The PS femoral component 14 depicted in FIGS. 1-8 may include a camelement or cam bar 50 and a box structure 52 for providing posteriorstabilization in place of absent ligaments. The cam bar 50 may include acam articulating surface 51 which may contact the posterior articulationsurface 42 of the post 30 during flexion, as in FIGS. 1B and 7. Aninternal articulation surface 54 may reside on the inside of the boxstructure 52 and may contact the post 30 during articulation androtation of the knee joint. The internal articulating surface 54 may beconcavely curved, and may contact the rim 44 of the post 30 during axialrotation of the knee joint about the post. The PS femoral component 14may further include a medial condyle 60 having a medial condylararticulation surface 62, and a lateral condyle 64 having a lateralcondylar articulation surface 66. The medial and lateral condylararticulation surfaces 62, 66 may articulate against the PS insert 12medial and lateral condylar articulation surfaces 25, 27 respectively. Agap 68 may be formed between the medial and lateral condyles 60, 64,with the cam bar 50 extending medial-laterally across the gap 68. Theinternal articulation surface 54 may include a medial portion 70continuous with a lateral portion 72. In the embodiment depicted, afixation post 74 may protrude superiorly from the PS femoral component14. However, in other embodiments of the PS femoral component 14, thefixation post 74 may be absent and/or other fixation features such asposts, spikes, pegs, webs, keels or teeth may be present to affix the PSfemoral component 14 to a prepared femur (not shown).

Referring to FIGS. 9 and 10, another assembly 110 embodiment of thedisclosure may include the PS insert 12 of FIGS. 1-8 coupled with acruciate retaining femoral component 114 (or “CR femoral component”).The CR femoral component 114 may include medial and lateral condyles160, 164, with a gap 168 formed between the medial and lateral condyles160, 164. As a CR femoral component 114, no cam bar or box may bepresent. The medial and lateral condyles 160, 164 may include medial andlateral condylar articulation surfaces 162, 166, and an internalarticulation surface 154 with medial and lateral articulating surfaces170, 172.

The medial and lateral articulation surfaces 32, 34 of the post 30 maybe tapered and may permit natural articulation of the CR femoralcomponent 114 with the PS insert 12, which may not be achievable if thepost 30 were not tapered. For example, if the post 30 had straight sidesinstead of tapered sides, the wider width of the post 30 at the base ofthe post 30 would interfere with the internal articulating surfaces 170,172 of the medial and lateral condyles 160, 164. When the PS femoralcomponent 14 is coupled with the PS insert 12 to form assembly 10, as inFIG. 1A and FIG. 4, the circular shape of the post superior end 40 incombination with the tapered medial and lateral articulation surfaces32, 34 of the post 30, may permit the PS femoral component 14 toarticulate relative to the PS insert 12 in the manner of a posteriorstabilized femoral component. However, when the PS insert 12 is pairedand implanted with the CR femoral component 114, the resultant assembly110 may provide the native articulation and rotation of a cruciateretaining implant.

Referring to FIGS. 11A-11E, an alternative embodiment of a tibial insert212 is shown. Tibial insert 212 may be referred to as a cruciateretaining tibial insert 212 (or “CR insert”). In a system of thedisclosure, CR insert 212 may be implanted with the CR femoral component114 and a tibial baseplate component (not shown) to form a cruciateretaining knee prosthesis system. The CR insert 212 may include afixation side 220, which may be an inferior side, opposite anarticulation side 222, which may be a superior side. The articulationside 222 may include a medial articulation portion 224 having a medialcondylar articulation surface 225 and a lateral articulation portion 226having a lateral condylar articulation surface 227. A central portion228 may separate the medial articulation portion 224 from the lateralarticulation portion 226. A recess 245 may be formed posterior to thecentral portion 228, between the medial and lateral articulationportions 224, 226, and may provide room for a posterior cruciateligament. The CR insert 212 may further include an insert base 246 andan engagement feature 248 for engagement with a tibial baseplatecomponent. The CR insert 212 may be coupled with the CR femoralcomponent 114 to form a cruciate retaining assembly. This assembly maybe implanted with a suitable tibial baseplate as a cruciate retainingknee prosthesis. The CR insert 212 may also be coupled with the PSfemoral component 14 and implanted with a suitable tibial baseplate.

Referring to FIGS. 12A-12F, another alternative embodiment of a tibialinsert 312 is shown. The tibial insert 312 may be referred to as aconstrained condylar knee (CCK) tibial insert 312 (or “CCK insert”). TheCCK insert 312 may include a fixation side 320, which may be an inferiorside, opposite an articulation side 322, which may be a superior side.The articulation side 322 may include a medial articulation portion 324having a medial condylar articulation surface 325 and a lateralarticulation portion 326 having a lateral condylar articulation surface327. A central portion 328 may separate the medial articulation portion324 from the lateral articulation portion 326. A post 330 may protrudesuperiorly from the central portion 328, and extend from a post base 338to a top, or post superior end 340. From the anterior perspective, asshown in FIG. 12E, and the posterior perspective, as shown in FIG. 12D,the post 330 may have its maximum medial-lateral or horizontal width atthe superior end 340 of the post 330, and its minimum medial-lateral orhorizontal width at the post base 338 of the post 330. The post 330 maybe bilaterally symmetrical from the anterior and posterior perspectives.The CCK insert 312 may further include an insert base 346 and anengagement feature 348 for engagement with a tibial tray (not shown).

The post 330 may have an articulation surface 331 extending around thepost 330 on the medial, posterior, lateral, and anterior aspects of thepost 330. The articulation surface 331 may include a medial articulationsurface 332, a lateral articulation surface 334, an anterior postsurface 336, and a posterior articulation surface 342. The medial andlateral articulation surfaces 332, 334 may taper slightly inward fromthe post superior end 340 to the post base 338 of the post 330 relativeto an insert midline vertical axis 2. However, some embodiments of CCKinsert 312 may include no taper of the medial and lateral articulationsurfaces 332, 334. The medial articulation surface 332 may be continuouswith the medial condylar articulation surface 325, and the lateralarticulation surface 334 may be continuous with the lateral condylararticulation surface 327. The anterior post surface 336 may extendbetween the medial and lateral surfaces 332, 334 and may be convexlyrounded. The anterior post surface 336 may taper outward from the postsuperior end 340 to the post base 338 relative to the midline axis 2, asbest seen in FIG. 12F. In other embodiments of the CCK insert 312, theanterior post surface 336 may include less taper, more taper, and/or notaper. The post 330 of the CCK insert 312 may be wider and bigger indiameter than the post 30 of PS insert 12, for example to provideincreased stability in the case of removal of the collateral ligaments.

Referring to FIG. 12B, the boundary of the post superior end 340 maydefine a rounded rim 344 shaped as a portion of a circle, from asuperior perspective. The post superior end 340 and rim 344 may besemi-circular as shown, however the rim 344 may define a circularenvelope 347. The post superior end 340 may be circular and rim 344 mayprovide increased surface contact and rotational range of motion whencoupled and implanted with the PS femoral component 14 in comparison totraditionally shaped posts with a more square or rectangular shapedpost. Thus, the rounded post superior end 340 and rim 344 may allow forsurface contact with the femoral component 14 in contrast to the merepoint or edge contact that is achieved by traditional posts that do nothave these features. The CCK insert 312 may be coupled with the PSfemoral component 14 to form a constrained condylar knee assembly, andthis assembly may be implanted with a suitable tibial baseplate as aconstrained condylar knee prosthesis. The CCK insert 312 may also becoupled with the CR femoral component 114 and implanted with a suitabletibial baseplate. Thus, all of the tibial inserts 12, 212, and 312disclosed herein are interchangeable with both the CR femoral component114 and the PS femoral component 14. FIG. 13 is a chart showing thepotential combinations of components.

The tibial inserts 12, 212, 312, PS femoral component 14 and CR femoralcomponent 114 may be grouped together as a modular knee replacementsystem and provided as a kit in one or more packages, in onenon-limiting example. Another kit may include a CR femoral component114, a PS insert 12 and a CR insert 212, in one or more packages inanother non-limiting example. Yet another kit may include a PS femoralcomponent 14, a PS insert 12, a CR insert 212, and a CCK insert 312, inone or more packages in yet another non-limiting example. However, itwill also be understood that other kit embodiments may utilize any ofthe tibial inserts and/or femoral components described herein in anynumber or combination, in one or more packages. Furthermore, othercomponents may also be including in any kit described herein, such assuitable tibial baseplate components, patellar components, etc., in oneor more packages. It will also be understood that any of the tibialinserts disclosed herein may be formed of vitamin E polyethylene, highlycross linked polyethylene, ultra-high molecular weight polyethylene(UHMWPE), or any other suitable material.

In a method of the disclosure, a patient may initially experiencecompromise of the anterior cruciate ligament. The ACL may be removed,and a CR type prosthesis may be implanted, including a CR femoralcomponent 114, a CR insert 212, and a tibial baseplate component. Later,the same patient may experience compromise of the PCL and may needadditional stabilization of the knee joint. The PCL may be removed, theCR tibial insert 212 may be removed, and a PS tibial insert 12 of thedisclosure may be inserted between the originally implanted CR femoralcomponent 114 and the tibial baseplate component, thus providingadditional stability for the missing PCL. Even later, the same patientmay experience instability of the collateral ligaments. The PS tibialinsert 12 may be removed, and the CCK tibial insert 312 of thedisclosure may be inserted between the originally implanted CR femoralcomponent 114 and the tibial baseplate component. Thus, the patient mayprogress from a CR knee prosthesis, to a PS knee prosthesis, and finallyto a CCK knee prosthesis without requiring replacement of the originallyimplanted femoral and/or tibial baseplate components. Theinterchangeability of the inserts 12, 212, 312 permit replacement ofonly the tibial insert component in order to provide increasing levelsof support and stability to the knee joint.

In another method of the disclosure, a patient may initially experiencecompromise of both the ACL and the PCL. These ligaments may be removed,and a PS type prosthesis may be implanted, including a PS femoralcomponent 14, a PS insert 12, and a tibial baseplate component. Later,the same patient may experience instability of the collateral ligaments.The PS insert 12 may be removed, and a CCK insert 312 may be insertedbetween the originally implanted PS femoral component 14 and the tibialbaseplate component. Thus, the patient may progress from a PS kneeprosthesis to a CCK knee prosthesis without requiring replacement of theoriginally implanted PS femoral component 14 and tibial baseplatecomponent.

Referring to FIGS. 14 and 15, another assembly 1010 of the disclosurefor an implantable knee prosthesis is shown in various exploded rearviews. The assembly 1010 may include a femoral component 1014 and atibial insert 1012. The tibial insert 1012 may be further coupled to atibial baseplate component (not shown) which may also be implanted in aprepared tibia of a patient (not shown). The femoral component 1014 andtibial insert 1012 illustrated in FIGS. 14 and 15 are right side femoraland tibial insert components. Left side femoral and tibial insertcomponents (not shown) would be mirror images of the right side femoraland tibial insert components that are shown in FIGS. 14 and 15. Thefemoral component 1014 may also be referred to as a posteriorstabilizing femoral component 1014 (or “PS femoral component”) and thetibial insert 1012 may also be referred to as a posterior stabilizingtibial insert (or “PS insert”).

FIGS. 16A-16D show the PS insert 1012 of FIGS. 15 and 14 in isolation.The PS insert 1012 may include a fixation side 1020, which may be aninferior side, opposite an articulation side 1022, which may be asuperior side. The articulation side 1022 may include a medialarticulation portion 1024 having a medial condylar articulation surface1025 and a lateral articulation portion 1026 having a lateral condylararticulation surface 1027. A central portion 1028 may separate themedial articulation portion 1024 from the lateral articulation portion1026. A post 1030 may protrude superiorly from the central portion 1028and extend from a post base 1038 to a post top 1040 or post superiorend. From the anterior perspective (shown in FIG. 16B) and/or theposterior perspective (shown in FIG. 16A), the post 1030 may have itsmaximum medial-lateral or horizontal width toward the top 1040 of thepost 1030, and its minimum medial-lateral or horizontal width toward thebase 1038 of the post 1030. The post 1030 may also be bilaterallysymmetrical from the anterior and/or posterior perspectives. A recess1045 may be formed posterior to the central portion 1028, between themedial and lateral articulation portions 1024, 1026, and may provideroom for a posterior cruciate ligament (not shown). The PS insert 1012may further include an insert base 1046, which may further include anengagement feature 1048 for engagement with a tibial baseplatecomponent.

Continuing with FIGS. 14-16D, the post 1030 may have an articulationsurface 1031 extending around the post 1030 on the medial, posterior,lateral, and anterior aspects of the post 1030. The articulation surface1031 may include a medial articulation surface 1032, a lateralarticulation surface 1034, an anterior post surface 1036, and aposterior articulation surface 1042. The medial and lateral articulationsurfaces 1032, 1034 may be non-parallel to one another and taper inwardfrom the post superior end 1040 to the post base 1038 relative to aninsert midline vertical axis 1002, as shown in FIGS. 16A and 16B. Asshown in FIG. 16A, an angle θ between the vertical axis 1002 and eachtapered surface 1032, 1034 may be about 6.5°, in at least oneembodiment. Since the post 1030 may be bilaterally symmetrical, theangle θ may be the same on both the medial and lateral sides 1032, 1034of the post 1030. In other embodiments of the disclosure, angle θ mayrange from about 6° to 11° degrees. The medial articulation surface 1032may be continuous with the medial condylar articulation surface 1025,and the lateral articulation surface 1034 may be continuous with thelateral condylar articulation surface 1027. The anterior post surface1036 may extend between the medial and lateral surfaces 1032, 1034 andmay be convexly rounded. The anterior post surface 1036 may also taperoutward from the post superior end 1040 to the post base 38 relative tothe insert midline vertical axis 1002, as best seen in FIG. 16D. Inother embodiments of the PS insert 1012, the anterior post surface 1036may include less taper, more taper, and/or no taper. A midlinemedial-lateral axis 1004 and a mid-line anterior-posterior axis 1006 arealso shown.

Referring to FIG. 16C, the boundary of the superior end 1040 may definea rounded rim 1044 shaped as a portion of a circle defined by a circularenvelope 1047, as seen from a superior perspective. The superior end1040 and rim 1044 may have a convex protrusion 1041 toward a posteriorend of the post 1030 as shown, and may permit passage of the posteriorcruciate ligament. The circular superior end 1040 with rim 1044 mayprovide increased rotational range of motion and surface contact againstthe femoral component 1014 in comparison to traditional posts with amore square or rectangular shape and no rim. Thus, the rounded superiorend 1040 and rim 1044 may allow for greater surface contact with thefemoral component 1014 in contrast to the mere point or edge contactthat is achieved by traditional posts that do not have these features.

The PS femoral component 1014 depicted in FIGS. 14-15 may includeaugment fixation apertures 1080, impact driver apertures 1090, a camelement or cam bar 1050, and a box structure 1052 for providingposterior stabilization in place of absent ligaments. The cam bar 1050may include a cam articulating surface 1051 which may contact theposterior articulation surface 1042 of the post 1030 during flexion. Aninternal articulation surface 1054 may reside on the inside of the boxstructure 1052 and may contact the post 1030 during articulation androtation of the knee joint. The internal articulating surface 1054 maybe concavely curved, and may contact the rim 1044 of the post 1030during axial rotation of the knee joint about the post 1030. The PSfemoral component 1014 may further include a medial condyle 1060 havinga medial condylar articulation surface 1062, and a lateral condyle 1064having a lateral condylar articulation surface 1066. The medial andlateral condylar articulation surfaces 1062, 1066 may articulate againstthe PS insert 1012 medial and lateral articulation surfaces 1025, 1027respectively. A gap 1068 may be formed between the medial and lateralcondyles 1060, 1064, with the cam bar 1050 extending medial-laterallyacross the gap 1068. The internal articulation surface 1054 may includea medial portion 1070 continuous with a lateral portion 1072. In theembodiment depicted, a fixation post 1074 may protrude superiorly fromthe PS femoral component 1014. However, in other embodiments of the PSfemoral component 1014, the fixation post 1074 may be absent and/orother fixation features such as posts, spikes, pegs, webs, keels orteeth may be present to affix the PS femoral component 1014 to aprepared femur (not shown).

Referring to FIGS. 17 and 18, another assembly 1110 embodiment of thedisclosure may include the PS insert 1012 of FIGS. 14-16D coupled with acruciate retaining femoral component 1114 (or “CR femoral component”).The CR femoral component 1114 may include a keel 1120, fixation members1130, impact driver apertures 1190, and medial and lateral condyles1160, 1164 with a gap 1168 formed between the condyles 1160, 1164. As aCR femoral component 1114, no cam bar or box may be present. Thecondyles 1160, 1164 may include medial and lateral condylar articulationsurfaces 1162, 1166, and an internal articulation surface 1154 withmedial and lateral portions 1170, 1172.

The tapered sides 1032, 1034 of the post 1030 may permit naturalarticulation of the CR femoral component 1114 with the PS insert 1012,which may not be achievable if the post 1030 were not tapered. Forexample, if the post 1030 had straight sides instead of tapered sides,the wider width of the post 1030 at the base of the post 1030 mayinterfere with the internal articulating surfaces 1170, 1172 of thecondyles 1160, 1164. When the PS femoral component 1014 is coupled withthe PS insert 1012 to form assembly 1010, as in FIGS. 14 and 15, thecircular shape of the post superior end 1040 in combination with thetapered medial and lateral surfaces 1032, 1034 of the post 1030, maypermit the PS femoral component 1014 to articulate relative to the PSinsert 1012 in the manner of a posterior stabilized femoral component.However, when the PS insert 1012 is paired and implanted with the CRfemoral component 1114, the resultant assembly 1110 may provide thenative articulation and rotation of a cruciate retaining implant.

Referring to FIGS. 19 and 20, another assembly 2110 embodiment of thedisclosure may include the PS insert 1012 of FIGS. 14-16D coupled with acruciate retaining femoral component 2114 (or “CR femoral component”).The CR femoral component 2114 may not include a keel, as opposed to theCR femoral component 1114 shown in FIGS. 17 and 18, and the CR femoralcomponent 2114 may be configured for cemented and/or cementless fixationto a femoral bone. The CR femoral component 2114 may include fixationmembers 2130, impact driver apertures 2190, and medial and lateralcondyles 2160, 2164 with a gap 2168 formed between the condyles 2160,2164. As a CR femoral component 2114, no cam bar or box may be present.The condyles 2160, 2164 may include medial and lateral condylararticulation surfaces 2162, 2166, and an internal articulation surface2154 with medial and lateral portions 2170, 2172.

The tapered sides 1032, 1034 of the post 1030 may permit naturalarticulation of the CR femoral component 2114 with the PS insert 1012,which may not be achievable if the post 1030 were not tapered. Forexample, if the post 1030 had straight sides instead of tapered sides,the wider width of the post 1030 at the base 1038 of the post 1030 mayinterfere with the internal articulating surfaces 2170, 2172 of thecondyles 2160, 2164. When the PS femoral component 1014 is coupled withthe PS insert 1012 to form assembly 1010, as in FIGS. 14 and 15, thecircular shape of the post superior end 1040 in combination with thetapered medial and lateral surfaces 1032, 1034 of the post 1030, maypermit the PS femoral component 1014 to articulate relative to the PSinsert 1012 in the manner of a posterior stabilized femoral component.However, when the PS insert 1012 is paired and implanted with the CRfemoral component 2114, the resultant assembly 2110 may provide thenative articulation and rotation of a cruciate retaining implant.

Referring to FIGS. 21A-21E, an alternative embodiment of a tibial insert1212 is shown. The tibial insert 1212 may be referred to as a cruciateretaining tibial insert 1212 (or “CR insert”). In a system of thedisclosure, the CR insert 1212 may be implanted with the CR femoralcomponents 114, 1114, 2114 and a tibial baseplate component (not shown)to form a cruciate retaining knee prosthesis system. The CR insert 1212may include a fixation side 1220, which may be an inferior side,opposite an articulation side 1222, which may be a superior side. Thearticulation side 1222 may include a medial articulation portion 1224having a medial condylar articulation surface 1225 and a lateralarticulation portion 1226 having a lateral condylar articulation surface1227. A central portion 1228 may separate the medial articulationportion 1224 from the lateral articulation portion 1226. A recess 1245may be formed posterior to the central portion 1228, between the medialand lateral articulation portions 1224, 1226, and may provide room for aposterior cruciate ligament. The CR insert 1212 may further include aninsert base 1246 and an engagement feature 1248 for engagement with atibial baseplate component.

The CR insert 1212 may be coupled with CR femoral components 114, 1114,2114 to form a cruciate retaining assembly. This cruciate retainingassembly may be implanted with a suitable tibial baseplate as a completecruciate retaining knee prosthesis. The CR insert 1212 may also becoupled with PS femoral components 14, 1014 to form a posteriorstabilizing assembly and implanted with a suitable tibial baseplate as acomplete posterior stabilizing knee prosthesis.

Referring to FIGS. 22A-22F, another alternative embodiment of a tibialinsert 1312 is shown. The tibial insert 1312 may be referred to as aconstrained condylar knee (CCK) tibial insert 1312 (or “CCK insert”).The CCK insert 1312 may include a fixation side 1320, which may be aninferior side, opposite an articulation side 1322, which may be asuperior side. The articulation side 1322 may include a medialarticulation portion 1324 having a medial condylar articulation surface1325 and a lateral articulation portion 1326 having a lateral condylararticulation surface 1327. A central portion 1328 may separate themedial articulation portion 1324 from the lateral articulation portion1326. A post 1330 may protrude superiorly from the central portion 1328,and extend from a post base 1338 to a top, or post superior end 1340.From the anterior perspective, as shown in FIG. 22E, and the posteriorperspective, as shown in FIG. 22D, the post 1330 may have its maximummedial-lateral or horizontal width at the post superior end 1340 of thepost 1330, and its minimum medial-lateral or horizontal width at thepost base 1338 of the post 1330. The post 1330 may be bilaterallysymmetrical from the anterior and posterior perspectives. The CCK insert1312 may further include a posterior recess 1345, an insert base 1346,and an engagement feature 1348 for engagement with a tibial tray (notshown). An opening 1350 may be present in the superior surface of thepost 1330.

The post 1330 may have an articulation surface 1331 extending around thepost 1330 on the medial, posterior, lateral, and anterior aspects of thepost 1330. The articulation surface 1331 may include a medialarticulation surface 1332, a lateral articulation surface 1334, ananterior post surface 1336, and a posterior articulation surface 1342.The medial and lateral articulation surfaces 1332, 1334 may taperslightly inward from the post superior end 1340 to the post base 1338 ofthe post 1330 relative to an insert midline vertical axis 1302. However,some embodiments of CCK insert 1312 may include less taper, more taper,and/or no taper of the medial and lateral articulation surfaces 1332,1334. The medial articulation surface 1332 may be continuous with themedial condylar articulation surface 1325, and the lateral articulationsurface 1334 may be continuous with the lateral condylar articulationsurface 1327. The anterior post surface 1336 may extend between themedial and lateral articulation surfaces 1332, 1334 and may be convexlyrounded. The anterior post surface 1336 may taper outward from the postsuperior end 1340 to the post base 1338 relative to the midline axis1302, as best seen in FIG. 22F. In other embodiments of the CCK insert1312, the anterior post surface 1336 may include less taper, more taper,and/or no taper. The post 1330 of the CCK insert 1312 may be wider andbigger in diameter than the post 30 of PS insert 12, for example toprovide increased stability in the case of removal of the collateralligaments. A midline medial-lateral axis 1304 and a mid-lineanterior-posterior axis 1306 are also shown in FIGS. 22D through 22F.

Referring to FIG. 22B, the boundary of the post superior end 1340 maydefine a rounded rim 1344 shaped as a portion of a circle, from asuperior perspective, and may have a convex protrusion toward aposterior end of the post 1330. The post superior end 1340 and rim 1344may be semi-circular as shown, however the rim 1344 may define acircular envelope 1347. The post superior end 1340 may be circular andthe rim 1344 may provide increased surface contact and rotational rangeof motion when coupled and implanted with the PS femoral componentsdisclosed herein in comparison to traditionally shaped posts with a moresquare or rectangular shaped post. Thus, the rounded post superior end1340 and rim 1344 may allow for greater surface contact with the femoralcomponents 14, 1014 in contrast to the mere point or edge contact thatis achieved by traditional posts that do not include these features.

The CCK insert 1312 may be coupled with the PS femoral components 14,1014 to form a constrained condylar knee assembly, and this assembly maybe implanted with a suitable tibial baseplate as a constrained condylarknee prosthesis. The CCK insert 1312 may also be coupled with any of theCR femoral components disclosed herein and implanted with a suitabletibial baseplate. Thus, all of the tibial inserts disclosed herein areinterchangeable with all of the CR and PS femoral components disclosedherein.

Any of the tibial inserts, CR femoral components, and/or PS femoralcomponents disclosed herein may be grouped together in any number orcombination as one or more modular knee replacement systems or kits. Aparticular kit may include a CR femoral component, a PS insert, and a CRinsert. Yet another particular kit may include a PS femoral component, aPS insert, a CR insert, and a CCK insert. Suitable tibial baseplatecomponents may also be included with any kit. Moreover, any of thetibial inserts disclosed herein may be formed of vitamin E polyethylene,highly cross linked polyethylene, ultra-high molecular weightpolyethylene (UHMWPE), and/or the like.

In an example method of the disclosure, a patient may initiallyexperience compromise of the anterior cruciate ligament. The ACL may beremoved, and a CR type prosthesis may be implanted, including a CRfemoral component, a CR insert, and a tibial baseplate component. Later,the same patient may experience compromise of the PCL and may needadditional stabilization of the knee joint. The PCL may be removed, theCR tibial insert may be removed, and a PS tibial insert of thedisclosure may be inserted between the originally implanted CR femoralcomponent and the tibial baseplate component, thus providing additionalstability for the missing PCL. Even later, the same patient mayexperience instability of the collateral ligaments. The PS tibial insertmay be removed, and the CCK tibial insert of the disclosure may beinserted between the originally implanted CR femoral component and thetibial baseplate component. Thus, the patient may progress from a CRknee prosthesis, to a PS knee prosthesis, and finally to a CCK kneeprosthesis without requiring replacement of the originally implantedfemoral and/or tibial baseplate components. The interchangeability ofthe inserts permits replacement of only the tibial insert component inorder to provide increasing levels of support and stability to the kneejoint.

In another example method of the disclosure, a patient may initiallyexperience compromise of both the ACL and the PCL. These ligaments maybe removed, and a PS type prosthesis may be implanted, including a PSfemoral component, a PS insert, and a tibial baseplate component. Later,the same patient may experience instability of the collateral ligaments.The PS insert may be removed, and a CCK insert may be inserted betweenthe originally implanted PS femoral component and the tibial baseplatecomponent. Thus, the patient may progress from a PS knee prosthesis to aCCK knee prosthesis without requiring replacement of the originallyimplanted PS femoral component and tibial baseplate component.

Referring now to FIGS. 23A-B, FIG. 23A is a perspective front view ofthe femoral component 1014 of FIG. 14 coupled to one or more augments1082, 1084 of the present disclosure and FIG. 23B is a medial side viewof the femoral component 1014 of FIG. 23A. As briefly mentioned abovewith reference to FIGS. 14 and 15, the femoral component 1014 mayinclude augment fixation apertures 1080 that may be configured to securethe one or more augments 1082, 1084 to the femoral component 1014, aswell as impact driver apertures 1090 configured to receive a femoralcomponent impact driver tool (not shown) to allow a surgeon to press fitthe femoral component 1014 to the end of a prepared femur. The augments1082, 1084 may be secured to the femoral component 1014 with fixationmembers 1086 and the augments 1082, 1084 may generally act to replacemissing and/or compromised femoral bone and allow the femoral component1014 to be adequately secured to a femoral bone under such conditions.

Referring now to FIGS. 24A-H, a femoral trial component 400 of thedisclosure is illustrated in FIGS. 24A-H. In particular, FIG. 24A showsa perspective top view of a femoral trial component of the disclosure,FIG. 24B shows a perspective rear view of the femoral trial component ofFIG. 24A, FIG. 24C shows a lateral side view of the femoral trialcomponent of FIG. 24A, FIG. 24D shows a medial side view of the femoraltrial component of FIG. 24A, FIG. 24E shows an anterior view of thefemoral trial component of FIG. 24A, FIG. 24F shows a posterior view ofthe femoral trial component of FIG. 24A, FIG. 24G shows a superior viewof the femoral trial component of FIG. 24A, and FIG. 24H shows aninferior view of the femoral trial component of FIG. 24A.

The femoral trial component 400 may be referred to as a universalfemoral trial component 400 because the femoral trial component 400 maybe used as part of a universal femoral trial system for preparing andtrialing a femoral bone of a patient (not shown) to receive a pluralityof different femoral implant types, as will be discussed in more detailbelow. The femoral trial component 400 may include a medial condyle 410having a medial condylar articulation surface 412, a lateral condyle 420having a lateral condylar articulation surface 422, an attachmentaperture 440 located intermediate the medial condyle 410 and the lateralcondyle 420, a patellar projection 430 located anterior to the medialcondyle 410 and the lateral condyle 420, a patellar articulation surface432, fixation member drill apertures 470, impact driver apertures 480,medial attachment features 450 proximate the medial condyle 410, andlateral attachment features 460 proximate the lateral condyle 420. Themedial attachment features 450 may further include a medial attachmentprojection 452, a medial attachment aperture 454 formed within themedial attachment projection 452, and a medial attachment recess 456.The lateral attachment features 460 may likewise include a lateralattachment projection 462, a lateral attachment aperture 464 formedwithin the lateral attachment projection 462, and a lateral attachmentrecess 466.

In practice, the femoral trial component 400 may be coupled to apartially prepared distal end of a femur (not shown). For example, apartially prepared distal end of a femur may include five distal cutsthat are made to the distal end of the femur using standard techniquesand tools (not shown) that are well known in the art. These five cutsmay be made to correspond in both shape and angle to the five surfaceson the inner portion of the femoral trial component 400, as best seen inFIGS. 24C and 24D. The femoral trial component 400 may then be press fitonto the partially prepared distal end of the femur and the femoraltrial component 400 may also be aligned relative to the distal end ofthe femur in the medial-lateral directions. The femoral trial component400 may then be used to further prepare the distal end of the femurand/or perform one or more trial operations with the femoral trialcomponent 400 still in place on the distal end of a femur.

For example, the attachment aperture 440 formed in the femoral trialcomponent 400, along with the medial and lateral attachment features450, 460, may be configured to receive any of a plurality of removablycouplable femoral bone preparation attachments and/or any of a pluralityof femoral trial attachments. Example femoral bone preparationattachments may include a posterior stabilizing notch cutting guideassembly 500, an augment cutting guide assembly (not shown), and a drilland broach guide assembly 700, as will be discussed in more detailbelow. Each of these femoral bone preparation attachments may beconfigured to removably couple to the universal femoral trial component400 to allow a femoral bone of a patient to be selectively modified andprepared to receive a selected femoral implant type. Example femoraltrial attachments may include a cruciate retaining trial attachment 800including a cruciate retaining central portion articulation surface 810and a posterior stabilizing trial attachment 600 including a posteriorstabilizing central portion articulation surface 610, as will bediscussed in more detail below. The cruciate retaining trial attachment800 and the posterior stabilizing trial attachment 600 may each beconfigured to removably couple to the universal femoral trial component400 to provide a central portion articulation surface 610, 810 above theattachment aperture 440 and allow for trialing of an articulationsurface for a selected femoral implant type that includes a medialcondylar articulation surface, a lateral condylar articulation surface,and a central portion articulation surface, for the selected femoralimplant type. In this manner, the femoral bone preparation attachmentsand the femoral trial attachments may be used to help finish preparingthe femur of the patient to receive any type of femoral componentdisclosed herein, and/or further perform one or more trial operationswith the femoral trial component 400 still in place on the femur, aswill be discussed in more detail below.

The femoral trial component 400 shown in FIGS. 24A-H is a right sidefemoral trial component 400 having a patellar projection 430 with aright angled medial-lateral shape, as best seen in FIGS. 24E and 24F,which mimics the patellar region of a right femur (not shown). Note howthe patellar projection 430 angles towards the right in the posteriorview of the femoral trial component 400 shown in FIG. 24F and towardsthe left in the anterior view of the femoral trial component 400 shownin FIG. 24E. A left side femoral trial component (not shown) will have apatellar projection 430 shape that is a mirror image of that shown inFIGS. 24E and 24F, having a left angled medial-lateral shape that mimicsthe patellar region of a left femur (not shown). In another embodimentof the disclosure illustrated in FIGS. 35A-C, a universal femoral trialcomponent 900 may include a patellar projection 910 with a universalshape that does not angle towards the right or left, but rather, thepatellar projection 910 in this embodiment may have a symmetricalmedial-lateral shape. In this manner, the universal femoral trialcomponent 900 shown in FIGS. 35A-C has a universal shape that may beused to prepare and trial both right and left side femurs. The patellarprojection 910 may have a patellar articular surface 912.

FIGS. 25A-26 illustrate a posterior stabilizing notch cutting guideassembly 500 that may be used with the femoral trial component 400 shownin FIGS. 24A-H to help prepare a femur of a patient to receive a PSfemoral component of the present disclosure by guiding bone resection.In particular, FIG. 25A is a perspective rear view of the posteriorstabilizing notch cutting guide assembly 500, FIG. 25B is anotherperspective rear view of the posterior stabilizing notch cutting guideassembly 500, FIG. 25C is a medial side view of the posteriorstabilizing notch cutting guide assembly 500, FIG. 25D is a top view ofthe posterior stabilizing notch cutting guide assembly 500, and FIG. 26is a partial exploded view of the posterior stabilizing notch cuttingguide assembly 500.

The posterior stabilizing notch cutting guide assembly 500 may include aposterior stabilizing notch cutting guide body 510 that includes amedial member 520 having a medial cutting guide surface 522 and medialchannels 524 formed therein, a lateral member 530 having a lateralcutting guide surface 532 and lateral channels 534 formed therein, and apatellar member 540 having a patellar cutting guide surface 542.

The posterior stabilizing notch cutting guide assembly 500 may alsoinclude a locking mechanism which may include: a first locking member552, a second locking member 554, a first release lever 562 coupled tothe first locking member 552 via a first pin 572, a second release lever564 coupled to the second locking member 554 via a second pin 574, afirst resilient member 592 located between the first release lever 562and the posterior stabilizing notch cutting guide body 510, with thefirst resilient member 592 housed in a first resilient member housing582, a second resilient member (not shown) similarly located between thesecond release lever 564 and the posterior stabilizing notch cuttingguide body 510, with the second resilient member housed in a secondresilient member housing 584.

The first resilient member 592 may be configured to apply a biasingforce that acts to push the first locking member 552 away from theposterior stabilizing notch cutting guide body 510 in the medialdirection and the second resilient member may be configured to apply abiasing force that acts to push the second locking member 554 away fromthe posterior stabilizing notch cutting guide body 510 in the lateraldirection.

Referring to FIGS. 27A and 27B, the posterior stabilizing notch cuttingguide assembly 500 may be removably coupled to the universal femoraltrial component 400 by squeezing the first release lever 562 and thesecond release lever 564 together toward each other (see arrows 501 inFIG. 27A) in order to overcome the biasing forces of the first resilientmember 592 and the second resilient member; then inserting the posteriorstabilizing notch cutting guide assembly 500 into the attachmentaperture 440 of the universal femoral trial component 400 (see arrow 502in FIG. 27A); and finally releasing the first release lever 562 and thesecond release lever 564 to allow the biasing forces of the firstresilient member 592 and the second resilient member to push the firstlocking member 552 and the second locking member 554 away from theposterior stabilizing notch cutting guide body 510, causing the firstlocking member 552 to enter within the medial attachment aperture 454 ofthe femoral trial component 400 and the second locking member 554 toenter within the lateral attachment aperture 464 of the femoral trialcomponent 400 to couple the posterior stabilizing notch cutting guideassembly 500 to the universal femoral trial component 400, as shown inFIG. 27B.

FIGS. 28A-D illustrate a posterior stabilizing trial attachment 600 thatmay be used with the femoral trial component 400 shown in FIGS. 24A-H toaid performance of one or more trial operations with the femoral trialcomponent 400 in place on the distal end of the femoral bone. Inparticular, FIG. 28A is a perspective rear view of the posteriorstabilizing trial attachment 600, FIG. 28B is another perspective rearview of the posterior stabilizing trial attachment 600, FIG. 28C is aperspective front view of the posterior stabilizing trial attachment600, and FIG. 28D is a perspective side view of the posteriorstabilizing trial attachment 600.

The posterior stabilizing trial attachment 600 may include a centralportion articulation surface 610, an internal articulation surface 620having a medial portion 622 and a lateral portion 624, a cam bar element630 having a cam bar articulating surface 632, a posterior stabilizingbox 670, and a gap 640 formed between the medial and lateral portions622, 624 within the posterior stabilizing box 670. Each of thesecomponents of the posterior stabilizing trial attachment 600, such asthe posterior stabilizing box 670 and the cam bar element 630, may beconfigured to allow for trialing of a complete posterior stabilizingfemoral implant.

The posterior stabilizing trial attachment 600 may also includeattachment projections 650, 660 on the medial and lateral sides of theposterior stabilizing trial attachment 600. The attachment projections650, 660 may have shapes that are complementary to the medial andlateral attachment features 450, 460 and/or the medial and lateralattachment recesses 456, 466 that are formed in the femoral trialcomponent 400. In this manner, the attachment projections 650, 660 maybe configured to couple to the medial and lateral attachment features450, 460 and/or the medial and lateral attachment recesses 456, 466formed in the femoral trial component 400, as shown in FIGS. 29A and29B. This may be accomplished by holding the posterior stabilizing trialattachment 600 above the femoral trial component 400 and moving theposterior stabilizing trial attachment 600 toward the attachmentaperture 440 formed in the universal femoral trial component 400 (seearrow 601 in FIG. 29A) until the posterior stabilizing trial attachment600 is coupled to the femoral trial component 400, as shown in FIG. 29B.In at least one embodiment, the posterior stabilizing trial attachment600 may be further configured to magnetically couple to the femoraltrial component 400.

In this manner, the posterior stabilizing trial attachment 600 mayremovably couple to the universal femoral trial component 400 andprovide the central portion articulation surface 610 above theattachment aperture 440 of the femoral trial component 400 to allow fortrialing of a complete articulation surface for a selected femoralimplant type, such as a PS femoral component disclosed herein. Acomplete articulation surface may include a medial condylar articulationsurface, a lateral condylar articulation surface, and the centralportion articulation surface 610, for the selected femoral implant type.

FIGS. 30A-31 illustrate a drill and broach guide assembly 700 that maybe used with the femoral trial component 400 shown in FIGS. 24A-H tohelp prepare a femur of a patient to receive a femoral component of thepresent disclosure that utilizes a keel or other bone fixation memberthat may require a pre-drilled and/or broached bone aperture. Inparticular, FIG. 30A is a perspective rear view of the drill and broachguide assembly 700, FIG. 30B is a perspective bottom view of the drilland broach guide assembly 700, FIG. 30C is a top view of the drill andbroach guide assembly 700, FIG. 30D is a bottom view of the drill andbroach guide assembly 700, and FIG. 31 is a partial exploded view of thedrill and broach guide assembly 700.

The drill and broach guide assembly 700 may include a drill and broachguide body 710, attachment projections 750, 760, and a drill and broachguide 720. The drill and broach guide 720 may further include a firstdrill guide aperture 721, a second drill guide aperture 722, a thirddrill guide aperture 723, a first broach guide aperture 725 intermediatethe first drill guide aperture 721 and the second drill guide aperture722, and a second broach guide aperture 726 intermediate the seconddrill guide aperture 722 and the third drill guide aperture 723. Thesecond drill guide aperture 722 may also be located intermediate thefirst broach guide aperture 725 and the second broach guide aperture726.

The drill and broach guide assembly 700 may also include a drill andbroach guide locking mechanism which may include: a first locking member742, a second locking member 744, a first release lever 732 coupled tothe first locking member 742 via a first pin 752, a second release lever734 coupled to the second locking member 744 via a second pin 754, and aresilient member 770 located between the first locking member 742 andthe second locking member 744 within a locking member housing 780 formedwithin the drill and broach guide body 710. The resilient member 770 maybe configured to apply a biasing force between the first locking member742 and the second locking member 744 to push the first locking member742 and the second locking member 744 away from each other.

Referring to FIGS. 32A and 32B, the drill and broach guide assembly 700may be removably coupled to the universal femoral trial component 400 bysqueezing the first release lever 732, and the second release lever 734together toward each other (see arrows 701 in FIG. 32A) in order toovercome the biasing force of the resilient member 770 between the firstlocking member 742 and the second locking member 744; then inserting thedrill and broach guide assembly 700 into the attachment aperture 440formed in the universal femoral trial component 400 (see arrow 702 inFIG. 32A); and finally releasing the first release lever 732 and thesecond release lever 734 to allow the biasing force of the resilientmember 770 to push the first locking member 742 and the second lockingmember 744 away from each other, causing the first locking member 742 toenter within the medial attachment aperture 454 of the femoral trialcomponent 400 and the second locking member 744 to enter within thelateral attachment aperture 464 of the femoral trial component 400 tocouple the drill and broach guide assembly 700 to the universal femoraltrial component 400, as shown in FIG. 32B. The attachment projections750, 760 may also have shapes that are complementary to the medial andlateral attachment features 450, 460 and/or the medial and lateralattachment recesses 456, 466 formed in the femoral trial component 400to aid coupling of the drill and broach guide assembly 700 to theuniversal femoral trial component 400, as well as magnetic couplingcapabilities.

FIGS. 40-44 illustrate an embodiment of a drill and broach guideassembly 1790 that may be used with the femoral trial component 400shown in FIGS. 24A-H to help prepare a femur of a patient to receive afemoral component of the present disclosure that utilizes a keep orother bone fixation member, which may require a pre-drilled and/orbroached bone aperture. In particular, FIG. 40 is a perspective view ofthe drill and broach guide assembly 1790, FIG. 41 is a side perspectiveview of the drill and broach guide assembly 1790, FIG. 42 is a bottomview of the drill and broach guide assembly 1790, FIG. 43 is a partialexploded view of the drill and broach guide assembly 1790, and FIG. 44is a partial exploded bottom perspective of the drill and broach guideassembly 1790.

The drill and broach guide assembly 1790 may include a drill and broachguide body 1710, attachment projections 1760 on opposing sides of thebody 1710, and a drill and broach guide 1720. The drill and broach guide1720 may further include a first drill guide aperture 1721, a seconddrill guide aperture 1722, a third drill guide aperture 1723, a firstbroach guide aperture 1725 intermediate the first drill guide aperture1721 and the second drill guide aperture 1722, and a second broach guideaperture 1726 intermediate the second drill guide aperture 1722 and thethird drill guide aperture 1723. The second drill guide aperture 1722may also be located intermediate the first broach guide aperture 1725and the second broach guide aperture 1726.

The drill and broach guide assembly 1790 may also include a drill andbroach guide locking mechanism. The locking mechanism may include ahandle 1700, with a grip 1701, a base 1702, a track 1703, and a handletab connection 1704. The handle 1700 fits within a cavity 1770 in thebody 1710 of the drill and broach guide, so that the handle tabconnections pass into the cavity 1770 and the base 1702 may rest on thebody 1710. The handle is attached to the body 1710 via pins 1711. Thehandle is operationally connected to a first tab 1740 and a second tab1741. The first tab 1740 and the second tab 1741 are extendable from thebase 1710 on opposing sides, as illustrated in FIGS. 40 and 41.

As illustrated in FIG. 42, the handle tab connection 1704 is visible inthe cavity 1770, in a bottom of the base 1710. The handle tab connection1704 is shown as two protrusions from the base 1702 of the handle 1700,which engage tab apertures 1746 in the first tab 1740 and the second tab1741. However, it is understood that the handle tab connection 1704 maybe any reasonable operational connection between the handle 1700 and thefirst tab 1740 and the second tab 1741. Other operational connectionsmay include protrusions on the first tab 1740 and the second tab 1741,which engage with apertures on the handle 1700. Operational connectionsmay include belt or screw drives, or any combination of bosses,bushings, or other bearing surfaces. The handle tab connection 1704engages and passes through proximal ends 1744 of the first tab 1740 andthe second tab 1741. A portion of the handle tab connections 1704,passing through and protruding through the proximal ends 1744 of thefirst tab 1740 and the second tab 1741, may engage rotation stops 1750on the body 1710 at the edge of the cavity 1770. The rotation stops 1750oppose one another across the cavity 1770, and are configured to limitthe movement of the handle tab connection 1704 about an axis that passesthrough the cavity 1770. The rotation stops 1750 are illustrated asbumps or protrusions but may have any structural configuration thatlimits movement of the handle 1700 about the axis.

The first tab 1740 and the second tab 1741 each have a proximal end1744, which is engaged with the handle 1700 as discussed above, a distalend 1743, and a compressible section 1745 connecting the proximal end1744 and the distal end 1743. The first tab 1740 and the second tab 1741are located within the body 1710 of the guide assembly 1790, so that theproximal ends 1744 are nearest the cavity 1770 and the distal ends 1743extend away from the cavity 1770, as shown in FIG. 42. The compressiblesections 1745 are depicted having spring-like configurations, but mayhave coiled or other resilient configurations.

FIGS. 43 and 44 illustrate more fully how the drill and broach guide1790 is operationally connected. The handle 1700 may rotate relative tothe body 1710 about the axis that passes through the cavity 1770. Thehandle 1700 is secured to the body 1710 via an engagement between pins1711, the body 1710, and the track 1703 of the handle 1700. The pins1711 each comprise a threaded section 1712 and a smooth section 1713.The pins 1711 are configured to screw into pin holes 1714 in the body1710. The threaded sections 1712 engage with complementary threadedportions of the pin holes 1714. When threaded in the pin holes 1744, thesmooth sections 1713 of the pins 1711 extend into the cavity 1770. Whenthe base 1702 of the handle 1700 is seated on the body 1710, the track1703 extends into the cavity 1770 and engages the smooth sections 1713of the pins 1711. The track 1703 and the smooth sections 1713 havecomplementary profiles, for example the track 1703 is concave and thesmooth sections 1713 are convex, which rest in the track 1703. Thesmooth sections 1713 engage with opposite sides of the track, whichfixes the handle 1700 to the body 1710, yet allows the handle 1700 torotate about the axis.

The rotation of the handle 1700, while operationally secured to the body1710, creates a camming action causing the first tab 1740 and the secondtab 1741 to extend from or retract into corresponding tab recesses 1771in opposing sides of the body 1710. As the handle 1710 is turned, thehandle tab connections 1704 act on the proximal ends 1744 of the firsttab 1740 and second tab 1741 pushing the tabs 1740 1741 out of the body1710. The protruding portions of the handle tab connections 1704 abutthe rotation stops 1750 preventing the handle from a complete rotation.The drill and broach guide assembly 1790 may be configured so that thehandle tab connections 1704 abut the rotation stops 1750 when the firsttab 1740 and the second tab 1741 are at a most-extended position, awayfrom the body. The compressible section 1745 of the first tab 1740 andthe second tab 1741 may be configured to apply a biasing force betweenthe distal ends 1743 and the proximal ends 1744 ends of each of the tabs1740 1741 and the handle 1700.

In operation, the drill and broach guide assembly 1790 may be removablycoupled to the universal femoral trial component 400 by inserting thedrill and broach guide assembly 1790 into the attachment aperture 440formed in the universal femoral trial component 400, similar to what isshown in FIG. 32A represented by arrow 702. The attachment projections1760 may also have shapes that are complementary to the medial andlateral attachment features 450, 460 and/or the medial and lateralattachment recesses 456, 466 formed in the femoral trial component 400to aid coupling of the drill and broach guide assembly 1790 to theuniversal femoral trial component 400, as well as magnetic couplingcapabilities. Once seated in the trial component, the handle 1700 may berotated so that the first tab 1740 and the second tab 1741 are extendedinto the medial attachment aperture 454 and the lateral attachmentaperture 464 of the femoral trial component 400. As the tab distal ends1743 abut walls of the attachment apertures 454 464, the compressiblesections 1745 begin to compress, creating the biasing force discussedabove. The handle 1700 may be turned further so that the handle tabconnections 1704 abut the rotation stops 1750. The combination of thebiasing force from the compressible sections 1745 in the medialattachment aperture 464 and the lateral attachment aperture 465 and theabutment of the handle tab connections against the rotation stops 1750,causes the drill and broach guide assembly to lock in place in thefemoral trial component.

FIGS. 33A-D illustrate a cruciate retaining trial attachment 800 thatmay be used with the femoral trial component 400 shown in FIGS. 24A-H toaid performance of one or more trial operations with the femoral trialcomponent 400 in place on the distal end of the femoral bone. Inparticular, FIG. 33A is a perspective front view of the cruciateretaining trial attachment 800, FIG. 33B is a perspective rear view ofthe cruciate retaining trial attachment 800, FIG. 33C is a perspectivebottom view of the cruciate retaining trial attachment 800, and FIG. 33Dis a top view of the cruciate retaining trial attachment 800.

The cruciate retaining trial attachment 800 may include a centralportion articulation surface 810, an internal articulation surface 820having a medial portion 822 and a lateral portion 824, and a gap 840formed between the medial and lateral portions 822, 824. Each of thesecomponents of the cruciate retaining trial attachment 800 may beconfigured to allow for trialing of a complete cruciate retainingfemoral implant.

The cruciate retaining trial attachment 800 may also include attachmentprojections 850, 860 on the medial and lateral sides of the cruciateretaining trial attachment 800. The attachment projections 850, 860 mayhave shapes that are complementary to the medial and lateral attachmentfeatures 450, 460 and/or the medial and lateral attachment recesses 456,466 that are formed in the femoral trial component 400. In this manner,the attachment projections 850, 860 may be configured to couple to themedial and lateral attachment features 450, 460 and/or the medial andlateral attachment recesses 456, 466 formed in the femoral trialcomponent 400, as shown in FIGS. 34A and 34B. This may be accomplishedby holding the cruciate retaining trial attachment 800 above the femoraltrial component 400 and moving the cruciate retaining trial attachment800 toward the attachment aperture 440 formed in the universal femoraltrial component 400 (see arrow 801 in FIG. 34A) until the cruciateretaining trial attachment 800 is coupled to the femoral trial component400, as shown in FIG. 34B. In at least one embodiment, the cruciateretaining trial attachment 800 may be further configured to magneticallycouple to the femoral trial component 400.

In this manner, the cruciate retaining trial attachment 800 mayremovably couple to the universal femoral trial component 400 andprovide the central portion articulation surface 810 above theattachment aperture 440 of the femoral trial component 400 to allow fortrialing of a complete articulation surface for a selected femoralimplant type, such as a CR femoral component disclosed herein. Acomplete articulation surface may include a medial condylar articulationsurface, a lateral condylar articulation surface, and the centralportion articulation surface 810, for the selected femoral implant type.

Any of the components disclosed herein may be included in a modularuniversal femoral trial kit (not shown) to aid in preparing and trialinga femoral bone of a patient to receive a plurality of different femoralimplant types. In at least one embodiment, the modular universal femoraltrial kit may include a container (not shown) that contains a femoraltrial component 400, 900 and at least one femoral bone preparationattachment, such as the posterior stabilizing notch cutting guideassembly 500 and/or the drill and broach guide assembly 700, as onenon-limiting example. In other embodiments, the modular universalfemoral trial kit may also include at least one femoral trialattachment, such as the cruciate retaining trial attachment 800 and/orthe posterior stabilizing trial attachment 600, as another non-limitingexample.

FIG. 36 illustrates a flow chart diagram of a method 3000 for preparingand trialing a femoral bone with a universal femoral trial component400, 900, according to one embodiment of the present disclosure. Themethod 3000 will be described in connection with the components andinstrumentation described herein. However, those of skill in the artwill recognize that alternative implants, assemblies, systems, andinstrumentation may be used in the performance of the method 3000.

The method 3000 may begin with a step 3010 in which a universal femoraltrial component 400, 900 may be placed on an inferior or distal end of afemoral bone. The distal end of the femoral bone may first be partiallyprepared with five distal cuts that are made to the distal end of thefemur using standard techniques and tools (not shown) that are wellknown in the art. These five cuts may be made to correspond in bothshape and angle to the five surfaces on the inner portion of theuniversal femoral trial component 400, 900 (e.g., see FIGS. 24C and24D). The universal femoral trial component 400, 900 may then be pressfit onto the partially prepared distal end of the femur.

In a step 3020, the universal femoral trial component 400, 900 may befurther aligned with respect to the femoral bone along a medial-lateraldirection in order to place the universal femoral trial component 400,900 at a desired medial-lateral location with respect to the femoralbone.

In a step 3030, one of a plurality of femoral bone preparationattachments may be selected in order to guide resection of portions ofthe femoral bone, as desired. Example, femoral bone preparationattachments may include the posterior stabilizing notch cutting guideassembly 500 and the drill and broach guide assembly 700, as twonon-limiting examples.

In a step 3040, the selected femoral bone preparation attachment may becoupled to the universal femoral trial component 400, 900 usingtechniques described previously herein (e.g., see description related toFIGS. 27A-B and FIGS. 32A-B).

In a step 3050, the femoral bone may be prepared to receive a desiredfemoral component by using the selected femoral bone preparationattachment as a guide to resect at least a portion of the femoral bonein order to prepare the femoral bone to receive the desired femoralcomponent. Once the femoral bone has been prepared with the selectedfemoral bone preparation attachment, the method may move to a step 3060.

In the step 3060, the selected femoral bone preparation attachment maybe removed from the universal femoral trial component 400, 900.

In a step 3070, one of a plurality of femoral trial attachments may beselected in preparation for performing one or more trial operations withthe universal femoral trial component 400, 900 still in place on thefemoral bone.

In a step 3080, the selected femoral trial attachment may be coupled tothe universal femoral trial component 400, 900 using techniquesdescribed previously herein (e.g., see description related to FIGS.29A-B and FIGS. 34A-B).

In a step 3090, at least one trial operation may be performed with theselected femoral trial attachment coupled to the universal femoral trialcomponent 400, 900, and the method 300 may end. For example, the surgeonmay perform trialing of articulation surfaces of the knee joint toensure that the articulation characteristics of the prosthetic kneejoint will be satisfactory.

Various steps of any method disclosed herein may be reordered, omitted,and/or replaced with different steps within the scope of the presentdisclosure. Those of skill in the art, with the aid of the presentdisclosure, will recognize that many variations may be made to any othermethod disclosed herein, depending on the particular surgical procedureto be carried out, as well as the configuration of the system used inthe performance of that surgical procedure. Moreover, any methodsdisclosed herein may include one or more steps or actions for performingthe described method. These method steps and/or actions may beinterchanged with one another. In other words, unless a specific orderof steps or actions is required for proper operation of the embodiment,the order and/or use of specific steps and/or actions may be modified.

FIG. 37 illustrates a flow chart diagram of a method 4000 for revising aknee joint prosthesis implanted in a knee of a patient to provideincreased stability to the knee joint prosthesis, according to oneembodiment of the present disclosure. The method 4000 will be describedin connection with the components and instrumentation described herein.However, those of skill in the art will recognize that alternativeimplants, assemblies, systems, and instrumentation may also be used inthe performance of the method 4000.

The method 4000 may begin with a step 4010, in which a first knee jointprosthesis that is implanted in a knee of a patient is surgicallyaccessed. The first knee joint prosthesis may comprise a first tibialinsert that is located between a tibial base plate component that isimplanted on a tibia of the patient and a femoral component that isimplanted on a femur of the patient.

The method 4000 may then proceed to a step 4020, in which the firsttibial insert may be removed from between the tibial base platecomponent and the femoral component.

The method 4000 may then proceed to a step 4030, in which a secondtibial insert may be inserted between the tibial baseplate component andthe femoral component to create a second knee joint prosthesis assemblythat is more constrained that the first knee joint prosthesis assembly,and the method 4000 may end.

FIGS. 38A-F and 39 illustrate an example tibial tray 5000 that may beused with any of the tibial inserts and femoral components describedherein to create various prosthetic knee assemblies, according toembodiments of the present disclosure. In particular, FIG. 38A shows aperspective front view of the tibial tray 5000, FIG. 38B shows aperspective rear view of the tibial tray 5000, FIG. 38C shows ananterior view of the tibial tray 5000, FIG. 12D shows a posterior viewof the tibial tray, FIG. 38E shows a bottom view of the tibial tray5000, FIG. 38F shows a top view of the tibial tray 5000, and FIG. 39shows an exploded view of an example tibial tray mounting system 6000that utilizes the tibial tray 5000.

The tibial tray 5000 may generally include a tibial base plate 5001 thatis superiorly mounted on top of a keel 5030. The tibial base plate 5001may have a superior end 5010 configured to receive any of the tibialinserts described herein, and an inferior end 5020 configured to engagea superior surface of a prepared tibia of a patient (not shown). Thesuperior end 5010 of the tibial base plate 5001 may include a posteriorlip 5012 and an anterior lip 5014, each configured to couple to andretain any of the tibial inserts described herein. The posterior lip5012 may have a notch 5016 to permit passage of ligaments and/or othersoft tissues. The superior end 5010 of the tibial base plate 5001 mayalso include a tibial insert retaining aperture 5050 configured toreceive a tibial insert retaining rod 6010, which may be used to furthercouple to and retain a suitable tibial insert to the tibial base plate5001, as shown in FIG. 39, provided the tibial insert has acorresponding opening in the post of the tibial insert configured toreceive the tibial insert retaining rod 6010 (e.g., see the tibialinsert shown in FIGS. 22A-F).

The inferior end 5020 of the tibial base plate 5001 may include one ormore spikes 5040 configured to penetrate tibial bone to further couplethe tibial base plate 5001 to the superior surface of a prepared tibia.The Keel 5030 may also include a medial fin 5032 and a lateral fin 5034each configured to penetrate tibial bone and provide additional couplingof the tibial tray 5000 to the tibia. Moreover, in some embodiments theKeel 5030 may also include a tibial stem aperture 5036 configured toreceive a tibial stem 6030 and/or a stem adapter member 6020 to furthercouple the tibial tray 5000 to the tibia of a patient (see FIG. 39). Thetibial stem 6030 may be configured to penetrate and reside within anintramedullary canal of the tibia to provide increased fixation of thetibial tray 5000 to the tibia.

It will be understood that the tibial tray 5000 and tibial tray mountingsystem 6000 shown in FIGS. 38A-F and 39 are merely one example of atibial tray and tibial tray mounting system that may be used with thetibial inserts and femoral components described in the presentdisclosure and that other tibial trays and tibial tray mounting systemsare also contemplated herein.

Reference throughout this specification to “an embodiment” or “theembodiment” means that a particular feature, structure or characteristicdescribed in connection with that embodiment is included in at least oneembodiment. Thus, the quoted phrases, or variations thereof, as recitedthroughout this specification are not necessarily all referring to thesame embodiment.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, Figure, or description thereof for the purpose ofstreamlining the disclosure. This method of disclosure, however, is notto be interpreted as reflecting an intention that any claim require morefeatures than those expressly recited in that claim. Rather, as thefollowing claims reflect, inventive aspects lie in a combination offewer than all features of any single foregoing disclosed embodiment.Thus, the claims following this Detailed Description are herebyexpressly incorporated into this Detailed Description, with each claimstanding on its own as a separate embodiment. This disclosure includesall permutations of the independent claims with their dependent claims.

The word “exemplary” is used herein to mean “serving as an example,instance, or illustration.” Any embodiment described herein as“exemplary” is not necessarily to be construed as preferred oradvantageous over other embodiments. While the various aspects of theembodiments are presented in drawings, the drawings are not necessarilydrawn to scale unless specifically indicated.

Recitation in the claims of the term “first” with respect to a featureor element does not necessarily imply the existence of a second oradditional such feature or element. Elements recited inmeans-plus-function format are intended to be construed in accordancewith 35 U.S.C. § 112 Para. 6. It will be apparent to those having skillin the art that changes may be made to the details of theabove-described embodiments without departing from the underlyingprinciples set forth herein.

The phrases “connected to,” “coupled to” and “in communication with”refer to any form of interaction between two or more entities, includingmechanical, electrical, magnetic, electromagnetic, fluid, and thermalinteraction. Two components may be functionally coupled to each othereven though they are not in direct contact with each other. The term“abutting” refers to items that are in direct physical contact with eachother, although the items may not necessarily be attached together. Thephrase “fluid communication” refers to two features that are connectedsuch that a fluid within one feature is able to pass into the otherfeature.

The Figures may show simplified or partial views, and the dimensions ofelements in the Figures may be exaggerated or otherwise not inproportion for clarity. In addition, the singular forms “a,” “an,” and“the” include plural referents unless the context clearly dictatesotherwise. Thus, for example, reference to a terminal includes referenceto one or more terminals. In addition, where reference is made to a listof elements (e.g., elements a, b, c), such reference is intended toinclude any one of the listed elements by itself, any combination ofless than all of the listed elements, and/or a combination of all of thelisted elements.

The term “substantially” means that the recited characteristic,parameter, or value need not be achieved exactly, but that deviations orvariations, including for example, tolerances, measurement error,measurement accuracy limitations and other factors known to those ofskill in the art, may occur in amounts that do not preclude the effectthe characteristic was intended to provide.

As used herein, the term “proximal”, “top”, “up” or “upwardly” may referto a location on the device that is closest to the clinician using thedevice and farthest from the patient in connection with whom the deviceis used when the device is used in its normal operation. Conversely, theterm “distal”, “bottom”, “down” or “downwardly” may refer to a locationon the device that is farthest from the clinician using the device andclosest to the patient in connection with whom the device is used whenthe device is used in its normal operation. Moreover, the terms “upper”and “lower”, and “top” and “bottom”, “front” and “rear” may be used asrelative terms herein for ease of description and understanding. It isunderstood that in embodiments of the disclosure, upper and lowerentities may be reversed, as may top and bottom, front and rear.

As used herein, the term “in” or “inwardly” refers to a location withrespect to the device that, during normal use, is toward the inside ofthe device. Conversely, as used herein, the term “out” or “outwardly”refers to a location with respect to the device that, during normal use,is toward the outside of the device.

While specific embodiments and applications of the present disclosurehave been illustrated and described, it is to be understood that thescope of this disclosure is not limited to the precise configuration andcomponents disclosed herein. Various modifications, changes, andvariations which will be apparent to those skilled in the art may bemade in the arrangement, operation, and details of the methods andsystems of the present disclosure set forth herein without departingfrom it spirit and scope.

What is claimed is:
 1. An assembly for facilitating orthopedic surgery,comprising: a body; a drill guide connected to the body; and anattachment mechanism connected to the body, the attachment mechanismcomprising: a first tab; a second tab; and a handle connected to thefirst and second tabs such that rotation of the handle about an axiscauses the first and second tabs to extend outward from the body tosecure the body to an external frame secured to a patient.
 2. Theassembly of claim 1, wherein the drill guide comprises at least onedrill guide aperture that extends through the drill guide and throughthe body.
 3. The assembly of claim 2, wherein the drill guide furthercomprises at least one broach guide aperture that extends through thedrill guide and through the body.
 4. The assembly of claim 3, whereinthe at least one drill guide aperture is in communication with the atleast one broach guide aperture.
 5. The assembly of claim 1, wherein thefirst tab and the second tab each comprise a proximal end and a distalend, and wherein the proximal ends of the tabs are adjacent to oneanother and the distal ends of the tabs extend away from each other. 6.The assembly of claim 5, wherein: the proximal ends of the tabs eachhave a handle attachment feature; wherein the handle further comprisestab attachment features complementary to the handle attachment featureson each of the tabs; and rotation of the handle about the axis causeseach of the first tab and the second tab to transition between aretracted position and an extended position, relative to the body. 7.The assembly of claim 6, wherein the proximal ends of the first andsecond tabs are located within a cavity in the body so that the handleattachment features and/or the tab attachment features extend into thecavity.
 8. The assembly of claim 6, wherein: at least one of the firsttab and the second tab further comprises a stop member; the body furthercomprises an abutment member; rotation of the handle causes the stopmember to engage the abutment member to retain the at least one of thefirst tab and the second tab in the extended position.
 9. The assemblyof claim 1, wherein: the first and the second tabs each comprise aproximal end, a distal end, and an intermediate section therebetween;and the intermediate section is compressible such that the proximal endand the distal end are configured to be translatable.
 10. The assemblyof claim 1, further comprising the external frame; wherein the externalframe is a trial component for joint arthroplasty.
 11. The assembly ofclaim 10, wherein: the first and the second tabs each comprise aproximal end, a distal end, and an intermediate section therebetween;the trial component comprises: a receiving aperture shaped to receivethe body; and locking apertures, in communication with the receivingaperture, shaped to receive the distal ends of the first tab and thesecond tab when the handle is rotated with the body positioned in thereceiving aperture.
 12. An assembly comprising: a body; a drill andbroach guide comprising: a first drill guide aperture; a second drillguide aperture; a third drill guide aperture; a first broach guideaperture intermediate the first drill guide aperture and the seconddrill guide aperture; and a second broach guide aperture intermediatethe second drill guide aperture and the third drill guide aperture,wherein the second drill guide aperture is intermediate the first broachguide aperture and the second broach guide aperture; and a lockingmechanism comprising: a handle connected to the body such that thehandle is rotatable about an axis; a first tab having a first proximalend, a first distal end, and a first compressible intermediate section,wherein the first proximal end has a first handle connection feature; asecond tab having a second proximal end, a second distal end, and asecond compressible intermediate section, wherein the second proximalend has a second handle connection feature; and wherein the handle ismovably connected to the first handle connection feature and the secondhandle connection feature such that, rotation of the handle about theaxis extends the first and second tabs outward from the body.
 13. Theassembly of claim 12, wherein the first and second tabs are locatedwithin a cavity in the body.
 14. The assembly of claim 12, wherein: atleast one of the first tab and the second tab further comprises a stopmember; the body further comprises an abutment member; and rotation ofthe handle causes the stop member to engage the abutment member toretain the at least one of the first tab and the second tab in anextended position.
 15. The assembly of claim 12 wherein: the handlefurther comprises a circular base and a grip portion, the circular basehaving a concave surface; the body further comprises an aperture,surrounding the axis, extending from a first surface of the body to asecond surface of the body, wherein the circular base engages theaperture; and the handle is rotatably secured to the base at theaperture by two pins extending into the base proximate an edge of theaperture, so that the pins securely engage the concave surface, allowingthe handle to rotate about the axis.
 16. The assembly of claim 12,further comprising an external frame; wherein the external frame is atrial component for joint arthroplasty; and wherein the trial componentcomprises: a receiving aperture shaped to receive the body; and lockingapertures, in communication with the receiving aperture, shaped toreceive the first and second distal ends of the first tab and the secondtab when the handle is rotated with the body positioned in the receivingaperture.
 17. An assembly for preparing and trialing a bone to receivean implant, the assembly comprising: a body; a drill guide connected tothe body; and an attachment mechanism connected to the body, theattachment mechanism further comprising: a first tab; a second tab; ahandle connected to the first and second tabs; wherein the assembly isconfigured to be removably coupled to a trial component by: rotating thehandle such that the first tab and the second tab are first in aretracted position; positioning the assembly adjacent to the trialcomponent, and rotating the handle such that the first tab and thesecond tab move to an extended position and engage within correspondingattachment apertures in the trial component.
 18. The assembly of claim17, wherein at least one of the first tab and the second tab furthercomprises a stop member and the body further comprises an abutmentmember; rotation of the handle causes the stop member to engage theabutment member to retain the at least one of the first tab and secondtab in in the extended position or a retracted position.
 19. Theassembly of claim 18, wherein: the first and the second tabs eachcomprise a proximal end, a distal end, and an intermediate sectiontherebetween; the handle engages the first tab and the second tab at theproximal ends; the handle is rotatable to transition the first andsecond tabs to the extended position so that the distal ends of thefirst and second tabs enter the corresponding attachment apertures inthe trial component; and the intermediate section is compressible suchthat, in response to the distal ends abutting a surface, theintermediate section is compressed to urge the stop member against theabutment member and prevents rotation of the handle.
 20. The assembly ofclaim 17, further comprising the trial component, wherein; the first andthe second tabs each comprise a proximal end, a distal end, and anintermediate section therebetween; the trial component is designed tofacilitate joint arthroplasty; and the trial component comprises: areceiving aperture shaped to receive the body; and locking apertures, incommunication with the receiving aperture, shaped to receive the distalends of the first tab and the second tab when the handle is rotated withthe body positioned in the receiving aperture.